CommercialAdministrativeMedium impact
Copay reminder for NPs and PAs
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Starting January 1, 2026, BCBS Rhode Island will apply specialist copays for Nurse Practitioners and Physician Assistants unless they are specifically credentialed as NP-PCP or PA-PCP with an assigned patient panel. Only NP-PCPs and PA-PCPs with panels will qualify for the lower PCP copay rate.
Action Required
Before January 1, 2026: Billing team must verify NP and PA credentialing status with BCBS Rhode Island to determine correct copay amounts. Update billing system to flag NP/PA visits for copay verification. Front desk staff must collect specialist copay amounts from patients seeing non-PCP credentialed NPs and PAs. Verify provider credentialing status in BCBS system before scheduling.